Intro and HTN p1 Flashcards
what type of a disease is HTN
a quantitative value rather than a qualitative disease
what does BP measure
the force of blood against the arterial walls
what is hypertension diagnoses based on
based on the average of two or more accurate, seated BP readings during two or more outpatient visits
what is the only exception of getting two or more accurate seated BP measures
hypertensive emergencies
What are the blood pressure classifications according to JNC 8
JNC is not testable (said in class)
what are the blood pressure classifications according to ACC/AHA
This is what were tested over (said in class)
what is the difference between primary and secondary hypertension
primary has no known etiology
secondary is due to a definable cause
what are common causes of secondary hypertension
- CKD
- Renal Artery Stenosis
- Cushing disease
- Coarctation of the Aorta
- Drug-Induced HTN
- Pheochromocytoma
- Hyperaldosteronism
- OSA
- Thyroid dysfunction
How does HTN typically present in patients <50
- Systolic AND diastolic BP rise
- predominantly caused by hormonal activation
- Associated with OSA
- Tx initiated when BP >140/90 (JNC)
How does HTN typically present in patients >60 years old
- systolic BP rises w/o rise in diastolic
- predominantly caused by arterial stiffness
- not associated with OSA
- Tx initiated when SBP >150 (JNC)
What is isolated systolic HTN
- occurs when Systolic BP >140 but diastolic is <90
who is isolated systolic hypertension MC in
older patients resulting from arterial stiffness and atherosclerosis
When isolated systolic hypertension occurs in younger patients, what demographic is MC? why does it occur?
MC in athletic males d/t higher stroke volume
what is the better risk predictor for consideration of long term HTN complications
<45 years old = DBP is better predictor
>60 years old = SBP is better predictor
what is white coat hypertension
persistently elevated >140/90 in the office , but a lower value outside of the clinic
what is the general consensus on treating white coat hypertension
Research suggest as long as numbers are within range at home, treatment is not necessary.
what is the opposite of white coat hypertension
masked hypertension:
normal BP in office but elevated values at home
what is psuedohypertension
Phenomenon that can occur in elderly patients that results from calcification of peripheral vessels.
results in falsely elevated BP, resulting in symptomatic overtreatment.
(patient presents with hypotensive symtpoms but BP still appears high. d/t vessels eing so calcified that you cant get an accurate reading! - said in class)
Is average SBP greater in young adult men or women
men
is age-related rise in BP higher in men or women
women
How does DBP change as we age
increases with age until about age 55, then decreases
HTN is a major risk factor for what
heart disease and stroke
how common is HTN in the different ethnicities
57.8% in non-Hispanic blacks
48.9% in non-Hispanic whites
45.2% in non-Hispanic Asians
38.6% in Hispanic Americans
what is different about those with non-hispanic black ethnicity
HTN manifests earlier, is more severe, higher rates of morbidity and mortality d/t stroke, LVH, CHF, ESRD than white Americans
how prevelant is HTN in older adults
77.1% in adults ≥65 y/o
what is the equation for BP
BP = Cardiac Output x systemic vascular resistsnace
Why is maintenance of BP so important?
- organ perfusion
BP must react to environmental changes to maintain this perfusion over a wide variety of conditions
what is the pathogenesis of primary HTN
results from complex interactions between multiple genetic, endogenous, and environmental factors
what are some of the causes of primary HTN
- Sympathetic nervous system hyperactivity
- Renin-angiotensin system activity
- Defect in natriuresis
- Abnormal cardiovascular or kidney development
- Elevated intracellular calcium and sodium levels
what occurs during sympathetic nervous system hyperactivity
“fight or flight” mode
d/t acetylcholine and NE release
what are the autonomic neurons that secrete acetylcholine called
cholinergic
what are the autonomic neurons that secrete NE called
adrenergic
when is Sympathetic Nervous System Hyperactivity most prevelant
younger patients
how does sympathetic nervous system hyperactivity usually present
tachycardia and elevated cardiac output
look at this later
k thanks
where do ACE inhibitors work in the RAAS system
preventing the enzyme ACE from converting angiotensin I to angiotensin II
What is natriuresis and how does it affect BP
Natriuresis is increased sodium excretion in the urine!
Increased salt triggers increased BP which promotes natriuresis to bring BP values back into normal range.
what is natriuresis defect
when there is a problem with natriuresis (salt excretion via kidneys) BP will increase resulting in HTN
How does the CV system normally control BP
elasticity of great arteries matches the resistance of peripheral arteries to optimize large vessel pressure waves
This serves to minimize oxygen consumption and maximize coronary flow
How can CV defects cause HTN
If the aortic elasticity or microvasculature is abnormal it increases the risk of HTN later in life
i couldn’t think of a better way to ask this
How does calcium play a role in HTN
HTN leads to increased intracellular sodium which can lead to increased intracellular calcium.
this leads to increased vascular smooth muscle tone which worsens hypertension?
this seems like a nice chart
cool
what are risk factors for HTN
- OSA
- Excessive Alcohol Use
- Cigarette Smoking
- NSAID use
- Obesity
- Low potassium or high sodium intake
- Metabolic syndrome
what are the three goals for evaluation of HTN
- assess presence of target-organ damage related to HTN
- determine presence of other cardiovascular risk factors and disease
- evaluate for possible underlying secondary causes of HTN
what are things that can hinder obtaining an accurate blood pressure
- using cuff over clothing
- arm unsupported not at heart level
- talking
- full bladder
- unsupported back
- crossed legs
- dangling feet
What is the process of obtaining an accurate BP
taken in both arms, two times, spaced 1-2 times apart at first office visit.
if value varies between extremities use higher value.
what are things to consider for home BP monitoring
- Allows for continued monitoring
- Helps dx white coat HTN
- Patient must be educated on how to use their device
- Ensure home device is accurate
be sure patient is taking BP after meds
what are the pros of ambulatory BP monitoring
- BP machine automatically obtains multiple readings over an extended period of time (typically 24 hours)
- Able to assess masked HTN and medication efficacy
- Helps assess nighttime risk of elevated BP or non-dipping BP
be sure patients are taking BP after meds
what history should you obtain from someone with HTN
what should be obtained on a PE for HTN
- complete vital signs
- signs of target organ or secondary causes of HTN
- head to to exam on initial assessment then focus on target organs on follow up visits
“this is just giving an overview from H&P of what youre doing and why youre doing it”
What Labs should be obtained from a patient with HTN
UA (protein)
BMP
EKG
Fasting Lipid profile
TSH
what are the complications of untreated HTN
- Structural and functional changes in the heart and vascular
- increased risk of thrombosis
- increase in morbidity and mortality related to hTN doubles fro each 6 mmHg increase in DBP
- target organ damage
what are examples of structural and functional changes in the heart and vasculature
LVH, Increased atrial size, CHF, Atherosclerosis, microvascular disease, cardiac arrhythmias
what are signs and symptoms of hypertensive cardiovascular disease
- dyspnea
- edema
- palpitations
- chest pain
- LV heave or S4 gallop
- LVH criteria on EKG
HTN increased risk for which major cerebrovascular diseases
- ischemic and hemorrhagic stroke
- dementia
when a patient already has microvascular disease d/t HTN, what should you be cautious of when treating them
Proper BP control may be able to PREVENT these changes, but once microvascular disease is noted, lowering BP can actually make symptoms WORSE
this is for things such as dementia!
what is hypertensive renal disease
chronic untreated HTN that results in nephrosclerosis
(more common in black patients!)
what percent of ESRD patients had untreated or poorly treated HTN
25%
what is the prognosis for hypertensive renal disease
it can be prevented with BP management but it is difficult to reverse any damage that has already occured
What is hypertensive retinopathy
narrowing of the retinal arteries
How does hypertensive retinopathy present on PE
Development of exudates, cotton-wool spots, and retinal hemorrhages
besides hypertension, what else increases risk of retinopathy
diabetes
what are the vascular complications of HTN
- atherosclerosis
- aortic aneurysm/dissection
what is atherosclerosis
condition that causes narrowing and/or hardening of arteries
How much can weight reduction affect BP
5-20mmHg decrease / 10 kg weight loss
I think this is the main thing, but considered memorizing this chart:
“Will not test you on this or expect you to regurgitate this”
what is the management recommendation for elevated BP? (120-129 and <80)
initiate non-pharmacologic therapy and reassess BP in 3-6 months
what is the management recommendation for stage 1 hypertension
assess 10 year ASCVD risk
* if >10% or clinical ASCVD begin pharm and non-pharm treatment
* if not, begin non pharm treatment only
what is the management recommendation for Stage 2 HTN
begin pharm and non pharm treatment
what is the goal BP for ALL patients with HTN
<130/80
what are the antihypertensive recommendations for non-african american patients?
thiazides
ACEI/ARB
CCB
what are the antihypertensive medication recommendations for african american patients
thiazides
CCB
how often should you follow up with your HTN patients
- once BP is controlled and meds proven safe you can follow up as rare as 6-12 months
what type of monitoring is needed for patients with HTN
- Labs not needed if BP is controlled
- EKG every 2-4 years depending on baseline EKG and symptoms.
